AB1449 ADHERENCE TO MTX AT INITIATION OF FIRST TARGETED THERAPY (PREVALENCE AND ASSOCIATED FACTORS): RESULTS OF THE STRATEGE2 STUDY.
Authors: C. Gaujoux-Viala, E. Dernis, E. Senbel, H. Herman-Demars, J. Becker, R. M. Flipo
Journal: Annals of the Rheumatic Diseases (2022)

Background Treatment adherence is a major challenge in chronic inflammatory rheumatic disease (CIRD). Mainly studied in rheumatoid arthritis (RA), this ranges from 30 to 80% [1]. Given the impact of non-adherence to disease-modifying therapy among RA patients, guidelines aiming to facilitate management of adherence were published in 2019 [2]. These guidelines highlight the multifactorial characteristics and importance of clarifying the factors determining non-adherence. In addition, treatment adherence was also listed as a point to consider for the management of difficult-to-treat RA by an EULAR task force [3]. Objectives Based on inclusion results of STRATEGE 2 we explore the adherence to methotrexate (MTX) and its associated factors prior to initiation of a first targeted therapy. Methods The objective of STRATEGE2 is to describe the therapeutic strategy in RA patients treated with MTX for at least 3 months, naive of targeted biological (bDMARD) or synthetic (tsDMARD) therapy and who are candidates for initiation of first b/tsDMARD therapy due to RA activity. Patients were included prospectively in 2019-2020 and completed the Compliance Questionnaire for Rheumatology (CQR) [4], a self-administered questionnaire specific to rheumatology, measuring treatment adherence. They were then divided into 2 groups: adherence (Ad) (CQR19&gt;80) vs. non-adherence (NAd) to investigate factors liable to be associated with adherence. Then, univariate and multivariate analysis was applied to identify potential predictors for adherence. Results Between Feb. 2019 and Dec. 2020, 230 patients were included, with 124 RA patients having an analysable CQR19: 73.4% females, mean age 56.6 years (±13.2), diagnosed 5.6 years (±7.4) previously, treatment with MTX for 4.4 years (±5.3) and a mean DAS of 4.3 (±1.2). The mean CQR score was 75.8. Patient distribution: 45.2% in the Ad group and 54.8% in the NAd group. Table 1. At baseline (before b/tsDMARD initiation) Ad - N=56 NAd - N=68 p Sex: female 73.2% 73.5% - Age (mean) 59.3 (±13.6) 54.4 (±12.4) p &lt; 0.05 BMI (mean) 27.2 (±7.0) 25.0 (±4.7) p &lt; 0.15 Still in work 39.3% 55.9% p &lt; 0.15 At least 1 comorbidity 60.7% 47.1% p &lt; 0.15 Positive anti-CCP 67.9% 80.6% p &lt; 0.15 Positive rheumatoid factor 69.8% 84.8% p &lt; 0.05 Radiological signs 57.1% 41.8% p &lt; 0.15 RA duration (years) 4.9 ±6.7 6.3 ±8.0 - Average MTX initiation (years) 4.0 ±4.7 4.8 ±5.7 - Per os MTX 28.6% 29.4% - → mean dosage (mg/week) 16.4 ±4.5 15.6 ±4.6 Subcutaneous MTX 69.6% 70.6% - → mean dosage (mg/week) 20.1 ±4.6 19.4 ±3.3 - Intramuscular MTX 1.8% 0% - Patients self-administration 30.0% 12.5% P &lt; 0.05 Corticosteroid therapy 53% 50.6% - → mean dosage (mg/day) 8.1 ±4.1 9.5 ±5.8 Mean DAS28 4.5 ± 1.3 4.2 ±1.2 - Mean HAQ 1.1 ± 0.7 0.9 ±0.7 p &lt; 0.15 In the multivariate analysis, no formal predictive factors to MTX adherence was identified except BMI&gt;30kg/m 2 (odds ratio, OR (95% confidence interval, CI)=4.00, 1.08-14.86, p=0,038) and adherents who estimate having completely participate to the decision-making for the targeted therapy (OR (95% CI)=6.41, 2.32-17.65, p&lt;0.001). Conclusion In this cohort, beyond the recently published guidelines, nearly half of patients do not show adherence to MTX (CQR19-based evaluation) before initiation of b/tsDMARD. As physicians tend to overestimate adherence to medication, clarification of the factors associated with non-adherence would help improve patient assessment and, therefore, management. Supplementary data on patients’ adherence evolution and adherence predictors, might be observed on the follow-up data at 12 and 24 months of this cohort. References [1]Beauvais C, et al. Joint Bone Spine 2020;87(6):668-669. [2]Gossec C, et al. Joint Bone Spine 2019;86(1):13-19. [3]Nagy G, et al. Ann Rheum Dis 2021; 0 :1–14. [4]De Klerk E, et al . J Rheumatol 2003;30(11):2469-2475 Acknowledgements The authors wish to acknowledge RCTs for their contribution to the statistical analysis, the investigators, centres and patients. Disclosure of Interests Cécile Gaujoux-Viala Speakers bureau: AbbVie; Amgen; Boehringer Ingelheim, Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Consultant of: AbbVie; Amgen; Boehringer Ingelheim, Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Emmanuelle Dernis Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Nordic Pharma, Roche-Chugaï Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Nordic Pharma, Roche-Chugaï Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Eric Senbel Speakers bureau: AbbVie, Amgen, Biogen, Janssen, Lilly, MSD, Nordic Pharma, Pfizer Roche-Chugai and Sandoz, Sanofi., Consultant of: AbbVie, Amgen, Biogen, Janssen, Lilly, MSD, Nordic Pharma, Pfizer Roche-Chugai and Sandoz, Sanofi., Hélène Herman-Demars Employee of: Nordic Pharma France, Jennifer Becker Employee of: Nordic Pharma France, René-Marc Flipo Speakers bureau: Abbvie, Bristol-Myers Squibb, Eli-Lilly, Janssen, Medac, MSD, Nordic-Pharma, Novartis, Pfizer, Roche-Chugaï, and Sanofi., Consultant of: Abbvie, Bristol-Myers Squibb, Eli-Lilly, Janssen, Medac, MSD, Nordic-Pharma, Novartis, Pfizer, Roche-Chugaï, and Sanofi.